Medicine and Torture

Organized psychiatry took a very different position than psychology on the question of who should participate in the interrogation of detainees in the War on Terror. In 2005, it came to light that the Department of Defense issued guidelines that permitted physicians to participate in the interrogation of detainees, and so called Behavioral Science Consultation Teams (BSCTs) were conducting in these interrogations in Guantanamo Bay, Cuba. In October 2005, as President of the American Psychiatric Association, I flew to Guantanamo Bay to visit the prison and to observe first-hand the ongoing role of physicians and psychologists in the interrogation process. I was accompanied by the President of the American Psychological Association as well as a number of interested parties, including Department of Defense personnel, the Surgeon General of the Army, and the Surgeon General of the United States. We spent a long day touring the prison, interviewing members of the BSCTs, and then, after flying back, spent a long evening at the Officers Club at Andrews Air Force Base debating the question of participation in the interrogation process. After that site visit, I took the issue to the governance of the American Psychiatric Association and, after a number of months, the APA endorsed a strong position statement which stated, “No psychiatrist should participate directly in the interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere.” Shortly after, the American Medical Association passed a similar resolution as did the Royal College of Psychiatrists in Britain. The American Psychological Association took a different position on the appropriateness and ethics of participation in interrogations and stated that it was permissible under certain conditions to participate in these interrogations to glean intelligence in the War on Terror. Pentagon officials said they would use only psychologists, and not psychiatrists, to help interrogators devise strategies to get information from detainees at places like Guantanamo Bay, Cuba. Dr. William Winkenwerder, Jr., Assistant Secretary of Defense for Health Affairs in the United States Department of Defense, told the New York Times (June 2006) that the new policy favoring the use of psychologists over psychiatrists was a recognition of differing positions taken by their respective professional groups.

Recently, an internal investigation conducted by the American Psychological Association revealed that psychologists in leadership at the American Psychological Association had multiple conflicts of interest in keeping the association’s ethics policies in line with the Defense Department’s interrogation policies. How was it that psychiatry differed so strikingly from psychology on this particular ethical issue?

Psychiatrists as physicians have strong ethical prohibitions in participating in torture that date back to the 1975 World Medical Association Declaration of Tokyo. This declaration stated, “Physicians can play no role whatsoever in torture or cruel, inhumane, and degrading treatment.” The question of interrogation of detainees and its relationship to torture has been a prominent issue in the news with detainees often subjected to stress interviews, sleep deprivation, and other more extreme measures to gain intelligence in the War on Terror. The policy positions of the American Psychiatric Association in contrast to the American Psychological Association took a number of months with some internal debate as to the relationship between interrogation and torture, with the American Psychiatric Association coming out firmly against psychiatrists’ participation in interrogation at any level. It was seen as consistent and in line with the ethical prohibition of physicians in executions, assisted suicide, and other areas where it would be clear that our Hippocratic Oath “to do no harm” would be violated. It is commendable that a group of dissidents within the American Psychological Association protested its association’s position on this issue and doggedly pursued it so that there would be a full investigation, which has brought to light the issues revealed in the report.